Skip to main content

Advertisement

SpringerLink
Log in

Symptoms Associated with Pregnancy Complications Along the Thai-Burma Border: The Role of Conflict Violence and Intimate Partner Violence

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

To assess the association between lifetime violence victimization and self-reported symptoms associated with pregnancy complications among women living in refugee camps along the Thai-Burma border. Cross-sectional survey of partnered women aged 15–49 years living in three refugee camps who reported a pregnancy that resulted in a live birth within the past 2 years with complete data (n = 337). Variables included the lifetime prevalence of any violence victimization, conflict victimization, intimate partner violence (IPV) victimization, self-reported symptoms of pregnancy complications, and demographic covariates. Logistic generalized estimating equations, accounting for camp-level clustering, were used to assess the relationships of interest. Approximately one in six women (16.0 %) reported symptoms related to pregnancy complications for their most recent birth within the last 2 years and 15 % experienced violence victimization. In multivariable analyses, any form of lifetime violence victimization was associated with 3.1 times heightened odds of reporting symptoms (95 % CI 1.8–5.2). In the final adjusted model, conflict victimization was associated with a 3.0 increase in odds of symptoms (95 % CI 2.4–3.7). However, lifetime IPV victimization was not associated with symptoms, after accounting for conflict victimization (aOR: 1.8; 95 % CI 0.4–9.0). Conflict victimization was strongly linked with heightened risk of self-reported symptoms associated with pregnancy complications among women in refugee camps along the Thai-Burma border. Future research and programs should consider the long-term impacts of conflict victimization in relation to maternal health to better meet the needs of refugee women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lozano, R., Wang, H., Foreman, K. J., Rajaratnam, J. K., Naghavi, M., Marcus, M. R., et al. (2011). Progress toward millennium development goals 4 and 5 on maternal and child mortality: An updated systematic analysis. Lancet, 378, 1139–1165.

    Article  Google Scholar 

  2. Austin, J., Guy, S., Lee-Jones, L., McGinn, T., & Schlecht, J. (2008). Reproductive health: a right for refugees and internally displaced persons. Reproductive Health Matters, 16, 10–21.

    Article  Google Scholar 

  3. Al Gasseer, N., Dresden, E., Keeney, G. B., & Warren, N. (2004). Status of women and infants in complex humanitarian emergencies. Journal of Midwifery and Womens Health, 49, 7–13.

    Article  Google Scholar 

  4. Back Pack Health Worker Team. (2010). Diagnosis critical: Health and human rights in Eastern Burma. Thailand: Maesot.

    Google Scholar 

  5. Lee, T. J., Mullany, L. C., Richards, A. K., Kuiper, H. K., Maung, C., & Beyrer, C. (2006). Mortality rates in conflict zones in Karen, Karenni, and Mon states in eastern Burma. Tropical Medicine and International Health, 11, 1119–1127.

    Article  Google Scholar 

  6. Koblinsky, M. (1999). Beyond maternal mortality—magnitude, interrelationship and consequences of women’s health, pregnancy-related complications, and nutritional status on pregnancy outcome. International journal of Gynecology and Obstetrics, 48, S21–S32.

    Article  Google Scholar 

  7. Gangopadhyay, R., Karoshi, M., & Keith, L. (2011). Anemia and pregnancy: A link to maternal chronic diseases. International Journal of Gynecology, 115, S11–S15.

    Article  Google Scholar 

  8. World Health Organization. (2000). Managing complications in pregnancy and childbirth: A guide for midwives and doctors. Geneva: WHO.

    Google Scholar 

  9. Hardee, K., Gay, J., & Blanc, A. K. (2012). Maternal morbidity: Neglected dimension of safe motherhood in the developing world. Global Public Health, 7, 603–617.

    Article  Google Scholar 

  10. Ivengar, K., Yadav, R., & Sen, S. (2012). Consequences of maternal complications in women’s lives in the first postpartum year: A prospective cohort study. Journal of Health, Population, and Nutrition, 30, 226–240.

    Google Scholar 

  11. Sarkar, N. N. (2008). The impact of intimate partner violence on women’s reproductive health and pregnancy outcome. Journal of Obstetrics and Gynaecology, 28, 266–271.

    Article  CAS  Google Scholar 

  12. Campbell, J. C. (2002). The health consequences of intimate partner violence. Lancet, 359, 1331–1336.

    Article  Google Scholar 

  13. Rodgers, C. S., Lang, A. J., Twamley, E. W., et al. (2003). Sexual trauma and pregnancy: A conceptual framework. Journal of Women’s Health, 12, 961–970.

    Article  Google Scholar 

  14. Mullany, L. C., Lee, C. I., Yone, L., Paw, P., Oo, E. K. S., Maung, C., et al. (2008). Access to essential maternal health interventions and human rights violations among vulnerable communities in Eastern Burma. PLoS Medicine, 5, 1689–1698.

    Article  Google Scholar 

  15. Zapata, B. C., Rebolledo, A., Atalah, E., Newman, B., & King, M. C. (1992). The influence of social and political violence on the risk of pregnancy complications. American Journal of Public Health, 82, 685–690.

    Article  CAS  Google Scholar 

  16. Kinyanda E, Musisi S, Biryabarema C, Ezati I, Oboke H, Ojiambo-Ochieng R, Were-Oguttu J, Levin J, Grosskurth H, Walugembe J. (2010). War related sexual violence and it’s medical and psychological consequences as seen in Kitgum, Northern Uganda: A cross-sectional study. BMC International Health and Human Rights, 10, 1–8.

    Article  Google Scholar 

  17. Bartlett, L. A., Jamieson, D. J., Kahn, T., Sultana, M., Wilson, H. G., & Duerr, A. (2002). Maternal mortality among Afghan refugees in Pakistan, 1999–2000. Lancet, 359, 643–649.

    Article  Google Scholar 

  18. Jamieson, D. J., Meikle, S. F., Hills, S. D., Mtsuko, D., Mawji, S., & Duerr, A. (2000). An evaluation of poor pregnancy outcomes among Burundian refugees in Tanzania. Journal of the American Medical Association, 283, 397–402.

    Article  CAS  Google Scholar 

  19. Howard N, Woodward A, Souare Y, Kollie S, Blankhart D, von Roenne A, Borchert M. (2011). Reproductive health for refugees by refugees in Guinea III: Maternal health. Conflict and Health, 5, 1–8.

    Article  Google Scholar 

  20. Chambliss, L. R. (2008). Intimate partner violence and its implication for pregnancy. Clinical Obstetrics and Gynecology, 51, 385–397.

    Article  Google Scholar 

  21. Coker, A. L., Smith, P. H., Bethea, L., King, M. R., & McKeown, R. E. (2000). Physical health consequences of physical and psycholgical intimate partner violence. Archives of Family Medicine, 9, 451–457.

    Article  CAS  Google Scholar 

  22. Ellsberg, M., Jansen, H. A. F. M., Heise, L., Watts, C. H., & Garcia-Moreno, C. (2008). WHO Multi-country study on women’s health and domestic violence against women study team. Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: an observational study. Lancet, 371, 1165–1172.

    Article  Google Scholar 

  23. Stark, L., & Ager, A. (2011). A systematic review of prevalence studies of gender-based violence in complex emergencies. Trauma, Violence, and Abuse, 12, 127–134.

    Article  Google Scholar 

  24. Annan, J., & Brier, M. (2010). The risk of return: intimate partner violence in Northern Uganda’s armed conflict. Social Science and Medicine, 70, 152–159.

    Article  Google Scholar 

  25. Heise, L. L. (1998). Violence against women: an integrated, ecological framework. Violence against Women, 4, 262–290.

    Article  CAS  Google Scholar 

  26. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Coordinating Center for Health Promotion, et al. (2007). Reproductive health assessment toolkit for conflict-affected women. Atlanta, GA: Centers for Disease Control.

    Google Scholar 

  27. Dhakal, S., van Teijlingen, E., Raja, E. A., & Dhakal, K. B. (2011). Skilled care at birth among rural women in Nepal: Practice and challenges. Journal of Health, Population, and Nutrition, 29, 371–378.

    Article  Google Scholar 

  28. Miller, E., Jordan, B., Levenson, R., & Silverman, J. G. (2010). Reproductive coercion: Connecting the dots between partner violence and unintended pregnancy. Contraception, 81, 457–459.

    Article  Google Scholar 

  29. Silverman, J. G., Gupta, J., Decker, M. R., Kapur, N., & Raj, A. (2007). Intimate partner violence and unwanted pregnany, miscarriage, induced abortion, and stillbirth among a national sample of Bangladeshi women. Bangladesh Journal of Obstetrics and Gynaecology, 114, 1246–1252.

    CAS  Google Scholar 

  30. Hynes, M., Sheik, M., Wilson, H. G., & Spiegel, P. B. (2002). Reproductive health indicators and outcomes among refguee and internally displaced persons in postemergency phase camps. JAMA, the Journal of the American Medical Association, 288, 595–603.

    Article  Google Scholar 

  31. Hyder, A. A., Noor, Z., & Tsui, E. (2007). Intimate partner violence among Afghan women living in refugee camps in Pakistan. Social Science and Medicine, 64, 1536–1547.

    Article  Google Scholar 

  32. Hobstetter, M., Walsh, M., Leigh, J., Lee, C. I., Sietstra, C., & Foster, A. M. (2012). Separated by borders, united in need: An assessment of reproductive health on the Thailand-Burma border. Cambridge, MA: Ibis Reproductive Health.

    Google Scholar 

  33. Decker, M. R., Miller, E., Kapur, N., Gupta, J., Raj, A., & Silverman, J. G. (2008). Intimate partner violence and sexually transmitted disease symptoms in a national sample of married Bangladeshi women. International Journal of Gynaecology and Obstetrics, 100, 18–23.

    Article  CAS  Google Scholar 

  34. Saha, S. R. (2011). Working through ambiguity: International NGOs in Myanmar. Cambridge, MA: The Hauser Center for Nonprofit Organizations, Harvard University.

    Google Scholar 

  35. Bartlett, L., Aitken, I., Smith, J. M., Thomas, L. J., Rosen, H. E., Tappis, H., et al. (2012). Addressing maternal health in emergency settings. In J. Hussein, A. McCaw-Binns, & R. Webber (Eds.), Maternal and perinatal health in developing countries. Oxfordshire: CABI International.

    Google Scholar 

  36. Sloan, N. L., Amoaful, E., Arthur, P., Winikoff, B., & Adjei, S. (2001). Validity of women’s self-reported obstetric complications in rural Ghana. Journal of Health, Population, and Nutrition, 19, 45–51.

    CAS  PubMed  Google Scholar 

  37. Souza, J. P., Cecatti, J. G., Pacagnella, R. C., Giavorotti, T. M., Parpinelli, M. A., Camargo, R. S., et al. (2010). Development and validation of a questionnaire to identify sever maternal morbidity in epidemiological surveys. Reproductive Health, 7, 1–9.

    Article  Google Scholar 

  38. Fox, J. (1997). Applied regression analysis, linear models, and related methods. London: Sage Publications.

    Google Scholar 

Download references

Acknowledgments

The authors are thankful to the American Refugee Committee, specifically Gary Dahl, Damarice Ager, Yoriko Jinno, Lara Hendy, and Catherine Carlson, and all the refugee staff, for survey leadership and implementation. Falb’s time was partially supported by MCHB grant 5T76 MC 00001(formerly MCJ201).

Author information

Authors and Affiliations

  1. Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, 4th Fl, New Haven, CT, 06520, USA

    Kathryn L. Falb

  2. Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA

    Marie C. McCormick

  3. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA

    David Hemenway

  4. American Refugee Committee, Minnesota, MN, USA

    Katherine Anfinson

  5. Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, USA

    Jay G. Silverman

Authors
  1. Kathryn L. Falb
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marie C. McCormick
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Hemenway
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katherine Anfinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jay G. Silverman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathryn L. Falb.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Falb, K.L., McCormick, M.C., Hemenway, D. et al. Symptoms Associated with Pregnancy Complications Along the Thai-Burma Border: The Role of Conflict Violence and Intimate Partner Violence. Matern Child Health J 18, 29–37 (2014). https://doi.org/10.1007/s10995-013-1230-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-013-1230-0

Keywords

Search

Navigation